We report herein a rare autopsy case of malignant lymphoma arising in the stomach, which recurred in the superficial lymph nodes and the skin 21 years after gastrectomy.
The patient, a 46-year-old man, had a history of gastrectomy under the clinical diagnosis of gastric cancer 23 years ago. At that time, on histological examination, the resected stomach was diagnosed as peptic ulcer. About 10 years after gastrectomy, superficial lymph node swellings and therapy-resistant eruptions in the skin appeared. Twenty-one years after gastrectomy, malignant lymphoma of the submandibular lymph node was diagnosed. Reevaluation of the resected stomach and regional lymph nodes revealed the presence of atypical small lymphocytes with irregular nuclei throughout the gastric wall and in the lymph nodes, indicating neoplastic proliferation rather than inflammatory infiltrates. Seventeen months after the diagnosis of malignant lymphoma, the patient died due to disseminated intravascular coagulation and multiple organ failure.
An autopsy disclosed hepatomegaly, splenomegaly and enlargement of the systemic lymph nodes. Histologically small to medium-sized atypical lymphoid cells infiltrated in the liver, spleen, systemic lymph nodes, kidneys, lungs, pericardium, pancreas, gallbladder and adrenal glands. The most interesting finding was the presence of Hodgkin-like cells admixed with small to medium-sized atypical lymphoid cells, especially in the liver, spleen, and lymph nodes.
An immunohistochemical examination on formalin-fixed and paraffin-embedded sections revealed that atypical lymphoid cells were reacted for T-cell markers (MT-1, UCHL-1, OPD4) but Hodgkin-like cells were not reacted for those antibodies.
In conclusion, the present case is interpreted that low-grade malignant lymphoma arising in the stomach transformed into a more aggressive type after 23 years.
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